Osteopathic Manipulative Medicine – PediaCast 384

Show Notes

Description

Drs Kimberly Wolf, Jen Bryant and Frances Comer stop by the PediaCast Studio to talk about osteopathic manipulative medicine. We explore the differences (and similarities) between MDs and DOs and consider the utility of a “hands-on” approach for the diagnosis and treatment of illness and injury. We hope you can join us!

Transcription

Announcer 1: This is PediaCast.

[Music]

Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike.

Dr. Mike Patrick: Hello everyone, and welcome once again to PediaCast. It is a pediatric podcast for moms and dads. This is Dr. Mike, coming to you from the campus of Nationwide Children's Hospital. We're in Columbus, Ohio.

It's Episode 384 for August 23rd, 2017. We're calling this one "Osteopathic Manipulative Medicine". I want to welcome you to the program.

I know lots of big words there, osteopathic manipulative medicine. And it's a pretty interesting thing and I'll have a rundown for you on exactly what it is. We'll talk about it in detail and how it could impact your family. So stick around.

But first, we are here at the end of August and most kids are headed back to school, or they will be heading back to school shortly. And since August is National Immunization Awareness Month, I wanted to take a moment to share some thoughts and resources with you as you consider immunizations in light of back-to-school time.

First, I just want to say, immunizations have probably saved more lives than just about any other health innovation. Okay, there's probably couple other things in the running. Sterile technique and sterilizing instruments has certainly saved many lives especially in the surgical theater. And of course, antibiotics are a huge discovery there. But immunizations are right up there with the sterilization of instruments and antibiotics, and a rightful member of the Big Three.

0:02:08

If you don't believe me, consider this — life expectancy dramatically increased over the course of the 20th century. So, if you look at 1900, the average life expectancy at that time was a 31 years of age. That was the average life expectancy, 31. In 1950, the average life expectancy was 48 years of age. And in 2000, it was 72 years of age.

So, this is remarkable to go from 31 as the average life expectancy to 72 in the course of those 100 years. And it's particularly incredible because the average life expectancy prior to the 20th century had been around 30 years of age for a really long time. Even going back to Ancient Rome, the average life expectancy was around 30 then, as well.

So, it didn't change much until the middle of the 20th century just as World War II was ending, which was really not that long ago as you consider the entire history of the world.

Now, here's a thing — and it's something that can get lost in the numbers — when we talk about average life expectancy, we're looking at it from the vantage point of a new born baby. However, if an individual made it out of childhood alive, then their life expectancy became much longer. In fact, if you look to the history books many historical figures lived to be a ripe old age but they had to make it out of childhood first.

So, let's consider some of America's founding fathers. George Washington lived to be 67, Tomas Jefferson – 83, Ben Franklin – 84. John Adams lived to be 90 years of age. And again, this is the time when the average life expectancy was around 30 years of age. And yet most adults, if they survived childhood, lived into their 60s, 70s and sometimes 80s or 90s.

0:04:09

Now, granted our founding fathers are privileged by the day's standards. They had access to the best nutrition and medical care that the time had to offer. But what about the American colonies? Just the typical guy living in the American colonies, the average life expectancy again for them was about 30 years of age, just like it had been for a very long time. But again, if an individual made it out of childhood, then their average life expectancy in the mid to late 1700s for men and women went from 30 to 64 years of age.

So, the most dangerous time to be alive, the point at which you were most likely to die was well before 30 years of age, which is why 30 is the average at a time when most adults lived into their 60s. So I say before 30 was the time you're most likely to die, unless of course you survived. And then, you will die more in your 60s. But the point is in order to get 30 as the average when most people were living into their 60s, to get to 30 as an average, it means that lots and lots and lots of children died during that time.

Now, moving forward medicine didn't change much between 1776 and 1900. So at the dawn of the 20th century, average life expectancy was still 30 and again because lots of kids died mostly from infectious diseases. And then in the 1940s, penicillin and immunizations began to be used widely. And by 1950, average life expectancy goes from 30 to 48 years of age. That's nearly 20 years of people living longer and virtually overnight. That's a huge historical jump.

And then, over the second half of the 20th century, so between 1950 and 2000, more types of antibiotics are produced. Additional immunizations are developed and approved and put into use. And average life expectancy jumps from 48 years of age to 72 years of age. And today, in 2017 here in the United States, average life expectancy is now 79 years of age.

0:06:18

Of course, there are other factors that come into play. Medical quality and consumer safety initiatives, new treatment options for cancers and diabetes and asthma. Lots of discoveries and innovations, but chief among them in this pediatrician's mind are antibiotics and vaccines which have resulted in a dramatic decline in childhood deaths.

Today, vaccines are safe. They're effective, and they're life-saving. And yet, children still die unnecessarily even today from vaccines preventable diseases, especially in the developing world were kids may not have access to vaccines.

Immunizations do not cause autism, we know this for a fact. It's far more dangerous to ride in a car to get a vaccine than it is to have the vaccine.

So, please take this opportunity here at the beginning of new school year and during National Immunization Awareness month. Let's be thankful for the medical pioneers who developed vaccines and take advantage of this amazing medical innovations which have dramatically lowered the number of childhood deaths. So, please visit your child medical provider soon and make sure he or she is up to date on their immunizations. Very important thing to do for your child's health and the future of your family.

We've covered vaccines in the past and in considerable detail on PediaCast. And I think we've done so fairly examining the science and the evidence, the benefits and the risks, hopefully a balanced approach. Few episodes to get you started for those who are interested and would like to learn more.

The Vaccine War Episode 329 was one of my favorite episodes that we recorded with the New York Time's best-selling author, Seth Mnookin, where we examined the historical events that led to the false notion that vaccines were associated with autism. Which again, we now know they are not.

0:08:13

And then also, Childhood Vaccines Part 1 and Part 2, which were PediaCast episodes 351 and 352 with the infectious disease and immunization expert, Dr. Mike Brady. We really just ran down the list and talk about each and every childhood vaccine, the diseases that each one treats and the real risks and benefits each one of those immunizations. It' s a long list which is why we devote two entire full-length episodes to vaccines.

Those shows, all those three that I just mentioned, are still relevant and up to date. So be sure to check them out and please share those shows with other parents who might be interested. Links for them just to make it easy to find are in the Show Notes for this episode, 384, over at PediaCast.org.

All right, let's move on. What are we talking about today? Osteopathic Manipulative Medicine. So there are two different types of medical schools that one can attend to becoming a license physician. There are allopathic schools of medicine which award the MD degree. That's the sort of medical school that I attended at the Ohio State University.

And then, there are osteopathic schools of medicine which award the DO degree like the Heritage College of Osteopathic Medicine at Ohio University, here in Ohio. MDs and DOs share many similarities but there are some differences as well, including the use of osteopathic manipulative medicine to diagnose and treat many medical disorders. This involves the use of the doctor's hands to manipulate or move body parts in diagnostics and therapeutic ways. And it's different than treatment offered by chiropractors or physical therapists.

So, this week we're going to explore the branch of medicine populated by osteopathic positions. We'll talk similarities and differences between DOs and MDs. We'll talk history and training. And in particular, we'll sort through the specifics of osteopathic manipulative therapy.

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And help me do that, we have a couple of, actually we have three fine osteopathic physicians to help us out as we raise awareness and understanding of their profession. Dr. Kimberly Wolf, Dr. Jen Bryant, and Dr. Frances Comer. All three of them will join me in the studio very shortly.

First though, I do want to remind you, if there's a topic that you would like us to talk about, it is easy to get in touch. Just head over to PediaCast.org, click on the Contact link and ask or suggest away. And we'll to try get your comments or your question on the program.

Also just real quick to let you know because there's not really a better time to do this. I did a TEDx style talk at an event here at Nationwide Children's called DISCOVERYx and talked about physicians engaging families and colleagues with digital content, like we're doing here on PediaCast. And just shared some thoughts about how to do that and how to do it well, and what kind of rich you can have. So, if you'd like to see me on the stage of the DISCOVERYx talking about digital content in podcasting, a little bit of a different venue than the podcast, I do have a link to the video in the Show Notes for this episode, 384, over at PediaCast.org. So you can check that out.

Also, I want to remind you, the information presented in every episode of our program is for general, educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. So if you have a concern about your child's health, be sure to call your doctor and arrange a face-to-face interview and hands-on physical examination.

Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement, which you can find at PediaCast.org. Let's take a quick break and I will be back to talk more about osteopathic manipulative medicine, it's coming up right after this.

[Music]

0:12:29

Dr. Mike Patrick: Dr. Kimberly Wolf is an osteopathic pediatrician at Nationwide Children's Hospital and an assistant professor of pediatrics at the Ohio State University College of Medicine. She joins us today as we explore the discipline of osteopathic medicine, including what it is — always a good place to start — the educational process, the differences and similarities between DOs and MDs, and the art of osteopathic manipulative therapy. Which can be used in the treatment of many disorders such as a strains and sprains, migraine headaches, ear infections, asthma, menstrual cramps, even constipation and lots of more. We're going to talk about many conditions that can be treated with this.

How, you ask? How does it work? Good question. Stick around for answers. That's why she's here to raise awareness and educate all of us on the ins and outs of osteopathic medicine and osteopathic manipulative treatment. So, let's give a warm PediaCast welcome to Dr. Kimberly Wolf. Thanks so much for being here today.

Dr. Kimberly Wolf: I'm so excited to be here and thank you for having me.

Dr. Mike Patrick: Yeah, absolutely. We also have Dr. Jen Bryant and Dr. Frances Comer in the studio. They're doctors of osteopathic medicine as well and current pediatric residents at Nationwide Children's. They're here to join the discussion. Welcome to both of you.

Dr. Jen Bryant: Thank you for having us.

Dr. Francis Comer: Yeah, we're happy to be here.

Dr. Mike Patrick: That's fantastic. Really appreciate all of you stopping us ad really educating all of us on these. So, let's start Dr. Wolf, what exactly is osteopathic medicine?

Dr. Kimberly Wolf: Such a great question and one I spent a lot of time answering over the course of my day. So, by training, I'm a DO, as well s Dr. Comer and Dr. Bryant who are here with me. And DOs are equivalent to MDs.

0:14:11

So, most of the time when you see us in the office, you won't know the difference between us if you come for a well check or your vaccines or just a sick visit like strep throat. However, we do some things that make us a little bit more unique. And one of those is OMM or osteopathic manipulative medicine which we're going to talk a little bit more about later.

One of the things that makes osteopathic medicine so unique, though, is our philosophy. So, even those of us who don't practice OMM every day have an underlying unifying philosophy which is based on four different tenets.

The first is the idea that the body is a unit. And I think we all agree about that and know that if something in the body isn't functioning right, it affects other parts as well.

The second is the idea that the body is capable of self-regulation and self-healing and health maintenance. And I think this is huge and one of the things that make us really unique. But again, this isn't a unique idea. We all know that if we get a cold, 99.9% of the time we're going to recover just fine from that. Same thing with the broken bone. So the body is really capable of doing amazing things.

The third tenet is the structure and function are reciprocally interrelated. And I know that sounds like a big word, but basically what we're saying is the structure is affected, the function is also altered as well. And again, when you think about this, it's pretty logical that if you break a leg, you can't walk.

And so then, the fourth tenet says that the rational treatment is based upon those other three ideas and that's really where we come from. So, we think of the body as one unit that tries to fix itself and our job is to come help it do that.

Dr. Mike Patrick: Yeah. You'd mentioned that the degree then the osteopathic physicians receive is the DO degree. And then the other side, the other physicians that we hear about is the MD degree. And that we would call the allopathic medicine. As you describe that — I'm an MD, you're a DO — so we come from a little bit of different training philosophies and background, and yet as you say those things, I think I can buy into all of that.

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Dr. Kimberly Wolf: Yeah. And that's why we think we're not so out there. I think we sort of have a lot of misconceptions and understandings about us that we're very different from you. But honestly, really, we learn all of the same things in our training. Dr. Comer's going to tell us a little bit about that coming up. But our underlying philosophy is really, again, something I think every MD agrees with, based on their practice of medicine.

Dr. Mike Patrick: Yeah, I feel like there was a split between… So, the first DO was actually an MD who split off and started his own medical school because of a difference in philosophy. And I feel like to some degree, we sort of come back together.

Dr. Kimberly Wolf: Yes.

Dr. Mike Patrick: I mean other than the lack of OMT training for MD physicians, I feel like we're pretty much brothers and sisters again.

[Laughter]

Dr. Kimberly Wolf: Absolutely, absolutely. We work side by side. In our clinic every day, we have MDs and DOs in our residency program here at Children's. We have MDs and DOs training our residents. So, again, we're very, very similar and day to day, you wouldn't know the difference between us.

Dr. Mike Patrick: Yeah. Now, tell us a little bit about the historical setting in which osteo, osteo-a-pathy, it's how you'd say the…

Dr. Kimberly Wolf: Osteopathy, yup.

Dr. Mike Patrick: Really arose from that allopathic or MD tradition, how did it get started?

Dr. Kimberly Wolf: So, we were founded in mid to late 1800s. Our founder is considered to be Alexander Taylor Still. And this was in Missouri, the very first school he founded was in 1892 in Kirksville, Missouri. And Dr. Still was an MD, as you said, and he sort of became disillusioned with the medicine that was happening around him at that time.

0:18:13

He was a little frustrated in the techniques he saw. They were doing some things that, of course today, we view just a little bit crazy like bloodletting and much more dramatic than we have today. But he really does had a pick for him when he lost three of his own children to spinal meningitis.

And one thing he started noticing when he was working with patients, where those patience that he put his hands on and treated things that he felt were out of place seemed to get better and have better results in the long term. And so, from that he sort of took that and founded his own philosophy and started his own osteopathic school and sort of grew from there.

And even though we were a smaller philosophy for a long time, we are growing. Dr. Comer actually informed me this morning of the official statistic that right now, we make up about 3 to 4% of all practicing physicians, but shortly we're going to be up to how much?

Dr. Francis Comer: Like 14 or 15% by say 2020.

Dr. Mike Patrick: Yeah. Is that because of new schools or larger classes within those schools or probably combination of those things.

Dr. Francis Comer: Combination, yeah.

Dr. Mike Patrick: So tell us, how things are similar in terms of if you're comparing MDs and DOs, folks will want to know, is the training up to par, the same as MDs? And do you take the same certifying exams and license by the same board, that sort of thing?

Dr. Kimberly Wolf: Yeah, so we are actually very, very similar. And like I said our degrees are equivalent with what we can do. So, as DOs, we can specialize in anything. We can be pediatricians, like all of us here today. However, we can also become neurosurgeons or heart surgeons or cancer specialist. Anything that we want, we are able to do.

We are able to prescribe. We are able to read imaging, all of those things that you think of for a regular doctor.

0:20:16

So, we do take similar board exams. We do have unique osteopathic board exams. However, us, as a DOs and osteopathic medical students are eligible to seat for all MD boards, both for specialties at the end of residency. And also during medical school, for your licensing.

I actually took a lot of the MD boards up until residency. And at that point, I really knew that my heart was with osteopathic medicine and so only pursued osteopathic board exams after that. But technically, my licensing up to residency was equivalent to an MD's.

Dr. Mike Patrick: Yeah. And that's the USMLE board exams that you can also take or you have the option of taking an osteopathic version of that?

Dr. Kimberly Wolf: Yup, it's called the COMLEX.

Dr. Mike Patrick: Great. For folks who are interested in learning more about colleges of osteopathic medicine which award the DO degree, there's 33 accredited colleges in 31 states, compared to 147 accredited allopathic schools. So that kind of gives you a sense of the mix of these schools now. And six of them are public colleges, including Ohio University here on Ohio with the teaching sites in Columbus and here at Nationwide Children's Hospital. And then, there 27 private institutions.

And if you'd like more information about the medical school side of osteopathic medicine, you can check out the website for the American Association of Colleges of Osteopathic Medicine. I'll have a link for you in the Show Notes for you over at PediaCast.org for this episode, 384.

And then, in addition to a different medical school and a different degree, which is again very equivalent, one of the things that really sets you apart is the teaching and practice of osteopathic manipulative medicine. And as we're finishing up our introduction here, we'll get more into specifics of exactly what that entails.

0:22:14

Dr. Comer, one of our pediatric residents here, so you're not too far out from your training as an osteopathic physician. Tell us a little bit about, so if there's a high school student who's interested in becoming a DO, kind of walk us through the path of how you get to where you are today.

Dr. Francis Comer: Yeah, certainly. The AACOM website that you reference is a great resource for high school students or anybody in the process of thinking about going into osteopathic medicine or medicine in general. And so, starting as a high school student, you'd go ahead and graduate from high school, of course. And then, go into undergraduate, get your general bachelor's degree.

You can go into any major that you are interested in. You don't have to necessarily do PreMed or Biology or Chemistry. One thing that makes a great doctor is being a well-rounded person. And so, I encourage people to seek what makes their heart happy when they're studying an undergrad, keeping in mind that we have prerequisites, the same prerequisites for a DO school as an MD school. And so, look up the website of whatever school you're interested in and you can see the prerequisites. So, we all have the same prerequisites.

And then, there is an application process. There's a different application for osteopathic schools than there is for allopathic schools. And AACOM is the website that you would get more information about applying to an osteopathic school.

And then, from there, the medical schools are very similar. You do two years of classroom-based learning. And as part of an osteopathic medical school, you do an extra 200 hours of training in osteopathic medicine. So, you also, in addition to doing the hands-on training, we have some lecture-based or problem-based training that we do.

0:24:12

I went to Ohio University — shoutout to the Bobcats — we had some integration into our case-based learning with osteopathic medicines. So even from the beginning of medical school, we start to think about those four tenets and incorporating the whole person (mind – body- spirit), thinking about how structure and function relate to disease or to wellness.

And then, from there after those two years of classroom-based learning, you go on to your third and fourth year, your clinical years, similar to any other medical school. And from there, I think you really incorporate more of that osteopathic training when you go out and you see patients and you're working and you can start to treat patients in that setting.

We, thankfully here, have an awesome opportunity to do that. Dr. Wolf takes a lot of medical students into our Hilltop Clinic, where she does a lot of the osteopathic teaching. And so, they have the opportunity. OU uses Columbus as a site like you said, and so they get the opportunity to do that in their third and fourth year.

Graduate from medical school, and then go on to residency or fellowship. Like she said, you can go into any specialty that you want. A lot of DOs choose to go into primary care. And so that's a majority, they say about 60% of DOs go into primary care and a lot work in rural and underserved area to serve a lot of people in need.

And if you choose to, you can go into a residency that has an osteopathic focus or what we are now calling osteopathically recognized, which thankfully here at our pediatrics program, we have an osteopathically recognized pediatrics program. The first in the country. There's now two, but we have a special opportunity to focus on osteopathic training in our residency, which is a really unique and amazing thing that we have here in Columbus.

0:26:08

Dr. Mike Patrick: Yeah, yeah. Absolutely. So, as you're describing all of these years of schooling starting with undergrad to the point where you are a practicing physician, we can be talking 11 or 12 years of training. And then if you sub-specialize or go into surgical specialties, it's even going to be longer than that. And so, really lots and lots of training goes into a practicing DO. And so, absolutely topnotch in terms of science training and patient training, too. And then, when we think of all the test, you'd also take the MCAT.

Dr. Francis Comer: Correct.

Dr. Mike Patrick: It's the same test that anyone who's applying to an allopathic medical school would also take. And then, three sets of board exams before your final licensure. So, lots and lots of study and testing really goes into this.

Dr. Francis Comer: Yeah.

Dr. Mike Patrick: So, let's focus in now on our topic for today which is osteopathic manipulative medicine. Dr. Wolf, tell us what exactly is that?

Dr. Kimberly Wolf: So, again this is a question I answer all day long in my clinic. But I'm very passionate about it. I'm now shy about questions, so keep them coming.

So OMM or osteopathic manipulative medicine, some people will also refer to as OMT, osteopathic manipulative therapy, osteopathic manipulative treatment. There's also another term that's out there, there is a movement within our profession to actually call it NMM or neuromuscular skeletal medicine. And so, those who actually get board certified in OMM are certified in OMM, NMM.

But no matter what letters you use, we're all doing the same thing which is using our hands to help the body work better, function better, move better. And we've got lots of different ways of doing that. I think when people think about us the most common thing they imagine is that we're cracking and popping similar to chiropractors.

However, a lot of my techniques are similar to massage. Some are similar to what athletic trainers do or physical therapist do on sidelines, with some stretching and muscle involvement. We also do some things that are even more gentle, that are gentle enough to even do on new born babies.

0:28:22

So, again, varying levels of pressures, varying levels of patient involvement and a different types of techniques, and a very different experience from patient to patient, which is one of the things that makes it cool.

What I love about OMM is, again, with each patient, I'm able to take them and evaluate them and decide what they need, and that what's really great. It's a little bit different than allopathic medicine, because almost every kid with an ear infection is going to get an amoxicillin when they go home. But I get kids with low back pain and I treat them very, very differently depending on what their problem is. And that's what makes us really cool and very unique.

Dr. Mike Patrick: And as you're talking about these procedures with your hands, I was reading that there's like 25 different types of manipulative procedures that you can do. And some of them are muscle and joint manipulations. But also, they can be used to improve circulation, lymphatic flow, reducing inflammations, or getting things functioning. I'm going to sound silly to the osteopaths in the audience.

Dr. Kimberly Wolf: No.

Dr. Mike Patrick: But getting things…

Dr. Kimberly Wolf: You're doing a great job.

Dr. Mike Patrick: Where they're suppose to be. I think the first question that the allopathic folks would ask is, is there evidence to show that these things actually do what you claim they do?

Dr. Kimberly Wolf: Yes. So, there is actually a lot of evidence out there about osteopathic manipulative medicine and also some other manipulative therapies and modalities that are used in other professions that support the evidence of what we do. However, most of them unfortunately are smaller trials which gives them less credibility in the scientific evidence-based world.

And they're often smaller trials because there's very few of us doing osteopathic manipulation. For example, at Children's Hospital, aside from my residents here at Nationwide, I'm the only physician currently doing osteopathic manipulation actively in my practice. And that's out of the hundreds of doctors we have here. So, that's one thing that gets in the way.

0:30:21

The others, a lot of what we do is again very very unique. So it makes it hard to design a protocol. So, again going back to the low back pain example, so some people have low back pain because there's actually problem in what we call the lumbar spine or low back. However, some people have low back pain because there's a problem with their hips. Some people have low back pain because they have unequal leg lengths and so, they're walking crooked.

So, if I treat each of those patients the same, they're not all going to get better. And that's why it's hard to make a protocol which is what's more often use in studies. And so, again I think that's one of biggest reasons where we're lacking good evidence.

Another thing is a lot of the responses I get are very hard to quantify. One of my favorite stories is I had a patient with a concussion and she came to me because she had heard through a friend that I had helped treat his concussions. She was like, "Well, I still get headaches. It's been a few years since my last one but everything else is fine." And then, one of the questions I always ask is about appetite in my kids with concussion. And she said, "No, my appetite is fine."

And then, the next week she came back, and I said, "Well, how are your headaches?" And she said, "You made my stomach growl for the first time in years." And she realized that she had been eating timed meals and had not really felt hungry since her concussion. And whether or not that was me or her body fixed it, or she just paid attention because I'd asked, I'm not sure. But that's a hard thing to write up as a quantifiable change.

Dr. Mike Patrick: Yeah, yeah. But the "N = 1" is important because she got better, regardless of what the exact mechanism was.

Dr. Kimberly Wolf: Yes, absolutely.

Dr. Mike Patrick: Her life was improved.

Dr. Kimberly Wolf: Absolutely. And that's why I do what I do. Those end of one's stories keep me going.

0:32:10

Dr. Mike Patrick: Yes, absolutely. And not to mention most of the scientific journals out there that would publish these reports come from an allopathic traditions which probably makes it even more difficult to fit the work into those journals.

Dr. Kimberly Wolf: Yes. It does because they have a little bit different standards that they're judging these things against. Because again, for us, the protocols are hard, the larger numbers are hard. It's very hard to do any blinding of someone. So designing a sham treatment for OMM, since it's a hands-on approach, is very difficult. Especially because with techniques such as cranial osteopathy, which is a very, very light touch. As soon as you put a baby in my hand, I'm usually treating them and most people won't even know. So, it's hard for me to do a "sham treatment" where my hands are on someone and I'm not influencing something.

Dr. Kimberly Wolf: So, there is some overlap of what we do, but I would stress that the biggest difference between us and chiropractors are we are fully licensed physicians. Again, we go through the same training that your MDs that you might be more familiar with do. And so, we're able to prescribe, we're able to do radiologies or imaging. We're able to refer to other specialists. Whereas chiropractors, they just do manipulative therapies. And that to me, again, is a very, very different training and level of knowledge that I'm approaching a patient with.

The founder of chiropractics actually studied under Andrew Taylor Still. They don't often talk about that and embrace that part of their history but it is out there and known that he did actually study under our founder.

Another difference is the types of manipulation, again, more often they do a lot of the high velocity or thrusting type techniques. Whereas again, us as osteopaths have lots of different styles of techniques that we're employing. And again, there's a lot of variability amongst the chiropractors, so some do different styles.

0:34:22

That's another thing that I love about us as osteopaths, we are very closely monitored and regulated. Whereas chiropractics, there's a lot of differences between practices and where they go. We're also covered under insurance. Sometimes chiropractors are, sometimes they're not, because they're not as closely regulated. So, again, there's a lot of advantages to coming to see us as DOs because we can do everything for you all in one place.

Dr. Mike Patrick: Yes, yes. There's another practitioner that has been sort of gaining ground out there called craniosacral therapists. So how are you different from them?

Dr. Kimberly Wolf: So, again the biggest difference is we're fully licensed physicians. Craniosacral therapy was actually taken by a DO who sort of made shortened and abbreviated course for lay people — so not medically trained personnel — to learn the foundation of what we call cranial osteopathy.

Cranial osteopathy is technique I use a lot in my clinic, not only in treating infants, like you heard me saying earlier, but headaches including concussions, migraines, TMJ, sinus issues, ear infections, and lots of other things. But for me to be certified in cranial osteopathy, I had to do the 200 hours of manipulation that Dr. Comer was talking about in medical school. And then, a 40-hour basic cranial osteopathy course on top of it, to be considered sort of competent to do that in my practice.

Whereas, where's those who do a craniosacral therapy course, they're not licensed physicians. They don't even have to be officially medical trained to my knowledge, I apologized if that's incorrect. That they can be lactation consultant, massage therapists, nurses. And then, they take usually, I think it's around a 24-hour course. So, again, just a huge discrepancy in the amount of training and background knowledge.

0:36:15

Dr. Mike Patrick: I would say, for folks out there, if you see a chiropractor or you see a craniosacral therapist and you get better, fantastic. I mean, we all want everybody to get. But if it's not working, then maybe don't discount manipulative therapy, maybe see a DO.

Dr. Kimberly Wolf: Yes, absolutely.

Dr. Mike Patrick: Okay.

[Laughter]

Dr. Kimberly Wolf: That's a great way to word it.

Dr. Mike Patrick: So, let's talk about physical therapy and occupational therapy, because then these are also licensed professionals who do manipulations. Dr. Bryant, tell us how osteopaths and osteopathic manipulative therapy is different from what physical therapists and occupational therapists do.

Dr. Jen Bryant: So, we usually have a lot of similarities with both of these professionals and consult them pretty often in our practice to help us do what we do. As far as physical therapy, it goes to focus on just one very small aspect of a physical therapist, they might be interested in improving motion and regaining motion. So if we see a kid that comes with an ankle sprain or an injury like that, they can go to PT and work on range of motion and strengthening exercises.

They can also come to us and we will do similar manipulations to improve range of motions and strengthening of the ankle but also focus on how that injury affects the rest of the body. So the compensations that your body makes by having to limp on that ankle or walk a little differently, and what that does to your other, like to your back, to your upper back and endings like that. So that we can focus on getting the entire body to function properly as the ankle heals and regains those.

Dr. Mike Patrick: And those physical therapists and occupational therapists are more likely to work with someone more long term to regain function, whereas what you guys do may be, I'm not going to say a one-time thing, but probably it's not serial, like three times a week.

Dr. Kimberly Wolf: Not three times a week but it depends on the conditions and what's going on. For example, torticollis babies, just like physical therapists, we'll see them about once a week. We often will too because those babies are growing and so they need constant monitoring of their conditions, as they're growing, and making sure that their condition doesn't get ahead of them.

0:38:24

Dr. Mike Patrick: Yeah, absolutely. Yeah, it's not very often that someone sees a physical therapist three time a week unless they're in the hospital or something or rehab.

So you'd mentioned that you're one of the only physicians here that's the DO who's doing osteopathic manipulative therapy. So how does that fit in to most DO's practice and why aren't there more DOs doing it?

Dr. Kimberly Wolf: That is a fantastic question. I encourage any DO listening to keep your hands in tune and use them as often as you can, because we definitely need more of us and there's a high demand for what we're doing. Patients really love it.

However, what it means for each DO is very different. There are some who do absolutely no manipulation in their practice and that might be because there are something like a radiologist or pathologist where they don't even interact with many patients. And then, there are those who use it every day like me. And there's again a variable scope, those who use it and mix it in with general practice. So, for example, yesterday, during my general pediatric session, I fixed a girl whose wrist had been hit by a soft ball. I had a three-year-old with constipation and treated him. And then I had another kid — I forget what my last one was — but I had one more kid that I did manipulation on in my general pediatric session. I think it was in the ear infection that I helped facilitate that drainage. Whereas, in my osteopathic clinic, I exclusively do OMM.

So, again there's variable amounts of involvement and I think it depends on the physician's level of comfort but also the practice that they would like. There are some practitioners who are board certified just in OMM or NMM and so their practices are exclusively manipulation.

But I think the numbers, the most recent that I had read is only about 6% of DOs, unfortunately, use OMM frequently in their practice.

0:40:21

Dr. Mike Patrick: I guess it's one of those things that the more you use it, the more confident you are in it, and the more comfortable you are. And so, you may learn something in medical school, but as time goes on and you get involved in training — and especially if you're not doing a lot of outpatient type of training, if you're doing something really specialized or spending a lot of time with hospitalized patients — then you sort of lose those skills and forget about them.

Dr. Kimberly Wolf: Yes, absolutely. And especially because there's so few of us doing it, it's very hard in your third and fourth year of medical school and residency to have someone supervise you and continue to train you and get your hands on. And then, by the time you get out into practice, some not have used their hands for five or six years. And so, it's very hard to pick that back up.

Dr. Mike Patrick: Let's talk about some specific conditions and talk more about exactly what it is that you do, sort of demystify this a little bit.

Dr. Kimberly Wolf: Okay.

Dr. Mike Patrick: So, since we're talking very often about the musculoskeletal system, let's just start with simple strains and sprains or the things that you can do to help when there's an injured muscle or stretched ligament or tendon.

Dr. Kimberly Wolf: Yeah. So, we do a lot with these. One of my favorite stories is when we were – I worked at the Diabetes Camp Hamwi for those Central Ohio Diabetic Association people. And I love sitting on the sideline as part of the medical staff because these kids just rolled an ankle, they come over to me and we kind of tune them up and fixed them and they were able to get out and play.

If you put your hand on someone right as that injury is happening you can stop a lot of that cascade that happens afterwards. So the edema or swelling that's about to happen, which mean there's inflammation in the area. And that's really when that pain gets worse and the mobility is more limited.

0:42:04

So, if we get our hands on those strains and sprains immediately, we can help actually stop some of that process from happening. But then also later on, if we treat them, like Dr. Bryant said we actually do targeted manipulations to help fix the actual injuries or strain or sprain, but also treat the compensations that the rest of the body has as a result of that injury.

Dr. Mike Patrick: And then, is a lot of that in terms of just getting things aligned where there suppose to be and then also decreasing some blood flow to the area? Is that how you decrease the inflammation?

Dr. Kimberly Wolf: Yeah. So, we actually there's techniques that we do like you said that influence the lymphatic system. And so, we encourage that drainage and that encourage the good cells that our body has in our immune function to come in and promote healing, as opposed to just the swelling that sits there and doesn't really bring good life to the area. I know it's kind of a vague way to describe that. But it doesn't bring the good stuff, it just kind of sits there with the bad irritated tissue.

Dr. Mike Patrick: So, you're not decreasing blood flow to the area, you're increasing lymphatic drainage out of the area. So that there's less congestion of fluid.

Dr. Kimberly Wolf: Yeah. And actually often increasing blood flow to the area as well. Because, again, you want that blood flow to bring the good stuff and to drain the bad stuff, too.

Dr. Mike Patrick: Sure. Totally makes sense. What about migraine headaches? This is one that we see a lot of folks with migraines in the emergency department. And it can be very frustrating. Is this more migraine prevention or treatment of an actual episode or a little bit of both?

Dr. Kimberly Wolf: Both. Absolutely both. Most of the time in clinic, I see patients when they're not having an acute headache — however, sometimes they will be having one — and again, what we can do is treatment of the actual head.

It sounds sort of crazy to us because we think about the head as one sort of solid bone. But the skull is really made up of over 30 individual bones. And even though those don't have a lot of motion, there's a lot of study showing that there is individual motion between those bones of the head. And so, that's what us, as osteopaths, are able to get in sort of move around to influence the structures underneath.

0:44:11

So, again changing the fluid flow underneath not only of blood, but also lymphatic because there is now something that was newly discovered recently — is the glymphatic system which the lymphatics for the brain. So, we think we have a large influence on that system with helping get rid of again bad things that are sitting there from irritated tissue and helping bring in the good stuff to help things heal.

We also can actually, through some of our techniques, influence cerebral spinal fluid flow, which is the fluid that surrounds the brain and spinal cord. So, again, helping that system work better and function better and restore the normal pressure that should be in that area, and the structures to where they belong and should be. So that they can function normally.

Dr. Mike Patrick: Since we're talking about the head, another common condition — especially more I think in teenagers and adults — is going to be TMJ or temporomandibular joint dysfunction, what can you do for that?

Dr. Kimberly Wolf: So, lots of things again, this is talking about those different bones of the head. So, like you said that's temporomandibular dysfunction. So, you have your temporal bone, which is everyone knows where our temple is. And then, that connects to the mandible or jaw bone.

So, that's the joint just like the joints in your back. So, I don't think it's a surprise to anyone that we treat ankles or backs, those are regular joints. But that's joint just like those, so we treat it the same way, get in there and increase mobility, make sure that things are aligned the way they're suppose to be. And this is really great for kids who bite their teeth or grind their teeth at night. Kids with a lot of anxiety who holds their tension in their jaw. We also treat the headaches the result from TMJ, not just the pain at that joint.

So, again a lot of things that we can influence and change with our hands.

Dr. Mike Patrick: So, if my wife says she feels that her jaw is clicking, it'd be good to see a DO?

Dr. Kimberly Wolf: Yes, we can fix it.

Dr. Mike Patrick: To help her out.

Dr. Kimberly Wolf: Yeah, we can fix a lot that.

Dr. Mike Patrick: If you're listening, Karen, you need to make an appointment with the DO.

[Laughter]

0:46:11

Dr. Mike Patrick: Okay. Moving on to little babies, torticollis, so this is when they have kind of a stiff neck over to one side and plagiocephaly where they can get a flat spot on the skull. We've talked about these things on PediaCast before. But osteopathic manipulative therapy can help these babies as well.

Dr. Kimberly Wolf: Yeah. So, this is one of my favorite conditions to treat. And a lot of the reason why I love treating these babies is people will argue all of the time that OMM or osteopathic manipulation is largely in part a placebo effect from getting hands-on and sitting and being talked to. And that might be the case, but I don't think I have a placebo effect on children who are non-verbal and some of them, newborns. So, it's hard to convince them to straighten their neck up.

Dr. Mike Patrick: Yes, yes.

Dr. Kimberly Wolf: Just by talking.

Dr. Mike Patrick: They don't listen.

Dr. Kimberly Wolf: They don't listen. So to me they are the perfect example of why what I do is beyond the placebo effect. But these babies, birth is pretty traumatic for all the parties involved. And a lot of times, torticollis starts either in utero, based on how they were positioned inside mom, or shortly after birth because of birth trauma that shifted again those 30 bones of the skull that you have at birth.

So, what we're able to get in there and do is actually treat not only the muscles of the neck with torticollis that are tight. But those muscles of the neck with the torticollis attached to bones of the skull. And so if you have that tight neck, you're pulling on those bones and that's often why these kids will get flat spot, they'll get facial asymmetry.

And although it's talked about is more of a cosmetic issue, it really has a lot of other influences. Because if you change those structures of the face and the head, you're influencing the drainage of ears so you might get more frequent ear infections because the tube that drains the ear is going through the skull.

0:48:07

You may get more frequent sinus infection by the same logic. You also might have problems with like dentition and meeting braces because there are two bones that form your upper teeth and two bones that form your lower teeth. And if those form asymmetrically, your teeth aren't going to line up and you might need braces or other orthodontic measures.

So it can even cause things like lazy eyes, because if the bones of the eyes are not lined up properly — there are seven of them in each eye — if those aren't lined up properly, it can pull on those muscles unevenly and cause problems with focusing unclear lazy eye.

So, again for us, it goes way beyond the cosmetic issue. And we do recommend getting it treated. We love what we do with osteopathic manipulations for these kids because a lot of times people will recommend physical therapy, which helps treat the neck but does not specifically address the head. Or they'll put them in helmets which the helmets might help, but they're pretty invasive. They have to wear them 24/7 from months on end versus coming to see me about 20 minutes once a week during this process.

And I'm able to treat the head and neck together. The helmet, the other thing they only treat the back of the head, so they don't fix that facial asymmetry and we're able to really get in there and do the fine detail where to fix the face as well. So, a really great option for kids with plagiocephaly or torticollis.

Dr. Mike Patrick: A lot of little babies also have latching issues with breastfeeding and osteopathic manipulation can help them as well?

Dr. Kimberly Wolf: Yeah. This is again another one my favorite things to treat because a lot of these babies I'll get. And moms will come in very frustrated and tired and exhausted and in tears because their baby just won't latch. They're doing everything that their pediatrician said and their lactation consultant said. And some of them have tried things like tongue revisions or clipping tongue ties and they're still very frustrated that the baby won't latch. And, usually, with one treatment, I'm able to get those babies to latch.

0:50:11

It depends on the problem underlying, obviously. But most of the time, we're able to do that. And again, that goes back to the trauma that happens with birth that shifts those muscles of the skull and the jaw. So if you shift that jaw bone and you have a crooked face, the muscles of the tongue are attached to that jaw bone. So, if that's crooked, the tongue is crooked and can't function properly or symmetrically. And that will often make it difficult.

Same thing with that torticollis. Often one of the first signs of torticollis is asymmetric breastfeeding. So, they'll do well on one side but not the other breast. And that's because they're having a hard time turning their head.

So, again we look at the whole body and fix all of those dysfunction. And we actually also, it sounds crazy, but we also treat the back of the skull where there's cranial nerves coming out. And those nerves get pinched. We all think of pinched nerves like in a lower back or down further in the neck that cause pain, but you get pinched nerves at the base of the skull after birth. And those are the nerves that are controlling your tongue, the back of your throat.

So these will be the babies that choke and gag all the time. It also can pinch what's called our vagus nerve which goes to stomach. So these babies will be very refluxy or spit up a lot and colicky and fussy.

And then, also the other cranial nerve that's coming out in that bundle back there is the one that controls what's called the sternocleidomastoid, which is the muscle that involved in torticollis. So, for us the anatomy, that cluster of nerves, treating that and releasing that pressure on that explains why you often see that constellation of symptoms all together.

Dr. Mike Patrick: You're making a good case for there being an osteopathic physician in the neonatal feeding clinic.

Dr. Kimberly Wolf: Yes, I think that's where we belong, and in every newborn nursery.

[Laughter]

0:52:08

Dr. Mike Patrick: So, speaking of infants and the young children, Dr. Bryant, we've mentioned kind of peripherally ear infections several times here. And I'm sure there are parents out there like, "No, get to that, get to that. My kids getting having lots of ear infections." How can osteopathic manipulation help kids who have recurrent ear infections?

Dr. Jen Bryant: So, we know that one of the major problems that causes the ear infections is the fact that the Eustachian tube that drains that middle ear is more horizontal. So that's up a great space for bacteria to grow, for fluid to accumulate. So, what we can do is actually several techniques that helps that area drain.

So there is one that called the Galbreath technique, where we can stretch the jaw and allow that fluid to drain out. There's different auricular drainage techniques from outside of the ear that we can use to get that to drain. But also influencing the sinuses, the nose, things like that, that are the start because often, ear infections start with the cold. And then, that fluid builds up and that's where the infection comes from. So we can drain the sinuses. We can help the nasal passages to drain better.

And then, we can also influence some lymphatic flow into the neck, so that everything has a place to go. Once we get it out of the ear, it can drain into the proper the places into the neck and the chest.

Dr. Mike Patrick: Yeah. Because when we've talked about this on this program before that the Eustachian tube, which sort of connects the back of the throat, nose area to the middle ear space oftentimes can just kind of floppy in a lot of kids and can become obstructed. And so, any bacteria that had gone up there like during a viral illness when the little cilia cells aren't working can get trapped there. And so, you really promoting opening that back up and getting things back where they're supposed to be in terms of moving from the middle ear space back down into the nose and mouth.

Dr. Jen Bryant: Absolutely. And oftentimes it's that accumulation that causes the pain. So they can get pretty immediate results just by one or two treatments in the office to allow that fluid to drain and then having that feel better. And sometime, you can even see with the otoscope immediately after treatment.

Dr. Mike Patrick: Yeah.

Dr. Kimberly Wolf: And fun trick that also works on airplanes to help pop kids' ears when they're screaming.

0:54:09

Dr. Mike Patrick: Absolutely. Yeah. When you think about it, I mean that's exactly when you do. You kind of move that area as best you can with your muscles to try to open up the Eustachian tube and get the air to become equally pressurized on both sides of the ear drum.

Now, one of the conditions that we hear about with the OMM is asthma, tell us the role of OMT, OMM, all these initials in asthma?

Dr. Jen Bryant: So, this actually a really exciting area for us now because we just completed a study looking at the effects of the OMM or OMT on asthma and more specifically the pulmonary function tester, the breathing test that the asthma kids do. And there was a positive influence and that these kids had improvement in their pulmonary function tests after treatment.

So specifically, what we're going to do is kind of twofold. One is working on all of the muscles of the ribcage including the diaphragm muscles of the neck that assist in breathing, so that kids can take a deeper breath. And that work of breathing is more even on both sides of the lungs, on each lung, and that they can expand their chest and exhale more easily.

The other thing that we can do is influence the nervous systems, both the parasympathetic and sympathetic nerves that are going to influence the constrictions of the airways. We can allow those nerves to kind of activate and open those airways up, as well as the secretion so we can clear them more easily.

Dr. Mike Patrick: Yeah. And I would point out this would not be a replacement for rescue inhaler.

Dr. Jen Bryant: Absolutely not.

Dr. Mike Patrick: So, and that's a great thing about DOs, like, "Okay, this is all fantastic but there's also a role for medicine and for standard of care kind of treatment for diseases."

Dr. Kimberly Wolf: Absolutely.

Dr. Jen Bryant: Which is the benefit of coming to see a DO because we can do both. We recognize in the middle of the treatment if someone comes in just for an osteopathic visit. We can say, "Okay, this is actually got a medical component, too. So, there's imaging that we need or there's prescriptions that we need to treat that part of it." And then use our hands in conjunction.

0:56:06

Dr. Mike Patrick: Yeah. Let's still use the albuterol when you're having trouble breathing.

Dr. Kimberly Wolf: Absolutely.

Dr. Jen Bryant: 100%.

Dr. Kimberly Wolf: We are not a replacement for that. Absolutely.

Dr. Mike Patrick: Dr. Comer, dysmenorrhea or menstrual cramps and discomfort. This is another area where osteopathic medicine can help?

Dr. Francis Comer: Yeah, certainly. And just a caveat to everything we've been talking about today. We always want to make sure we rule out those serious medical problems or treat things with medications when appropriate. So, like with asthma, making sure you stay on your maintenance. Medications and use your albuterol antibiotics are certainly important in ear infections. And then, with dysmenorrhea, there's some people who have a true medical problem that's causing that dysmenorrhea and we want to make sure we rule those things out.

But if you continue to have pain and we know that's there's no serious medical problem going on where you can certainly come to us for both parts. But we like to use the osteopathic treatment in conjunction with typical medical treatment and making sure that those things that are really serious, we rule out.

And with that, we can focus on some of the things that Dr. Bryant was talking about with — parasympathetic and sympathetic — and for everyone out there, that's your fight or flight type of thing that you think about. So, your fight or flight is your sympathetic nervous system. And then, your parasympathetic is your rest and digest nervous system.

And so, those things can affect your menstrual period, your cramping and those nervous systems kind of work together in your uterus. So, we can do some things to work on the places where those nerves live and come from. And in the uterus, that's the low back and the pelvis and the sacrum. And the sacrum is the base of your spine, kind of your toxics area, in that area, and we can focus on those things and treat those nerves to help make sure that they're not getting pinched or affected by some musculoskeletal problem in that area. And that can help.

0:58:05

And then, we can also focus on those synthetics and the drainage. We have a diaphragm, we think about our big diaphragm that helps us breath. We also have a diaphragm in the pelvis called the pelvic diaphragm and we can work on that area, too, to help with the lymphatics and fluid drainage. Because you might feel bloated when you're having those menstrual cramps. And so, we can help with some of that fluid as well.

Dr. Mike Patrick: Yeah, absolutely. And I would think constipation then would be along those similar lines in terms of getting things to move and smooth muscle and nervous system activation.

Dr. Francis Comer: Exactly, exactly yes. So, our parasympathetics, our rest and digest, are really important. And so, if those aren't working — those come from the sacrum from much of the colon, as well as what Dr. Wolf was saying with the vagus nerve up in the head — and so, we think about those things making sure those are working, so that you're moving everything out. And then, also with your sympathetic, if those are really active, that'll stop you up and keep you from moving.

So, we think both of those things. And then we can also focus on the abdomen itself, our belly. Sometimes, when people have surgeries, they might have some scar tissue in there that can keep our intestines from moving as well as they should. So, we can directly treat some of those things to help get the scar tissue moving and get our function back in our bellies.

Dr. Mike Patrick: Yeah. And again, this is a situation where there may be some medicine or dietary changes that go along with that, but then once you deal with the nervous system component of it, then that can prevent the problem from happening again, hopefully.

Dr. Francis Comer: Yeah, certainly. We always think about these things in conjunction with traditional medicine. And so, sometimes, people do need to drink more water and eat more fruits and vegetables. And if we know that we're not seeing results and we think that we need the help of a specialist, we always refer to a specialist as well if we think that that's appropriate.

Dr. Mike Patrick: Yeah, absolutely.

Dr. Kimberly Wolf: One of the reasons these pattern gets sustained is what called viscerosomatic reflex. And that's a huge word, but viciro means your guts or organs, and somatic is what we think of for the musculoskeletal systems. So bones, muscles, ligaments.

1:00:13

And all of those systems communicate in the spinal cord. So sometimes, signal gets crossed and that's why you might see back pain in someone who has constipation because the body saying it's upset at what's happening in the gut. But it sends a signal to the spinal cord and instead of sending it back to the gut, that signal got crossed and got sent to the muscles in the lower back.

In the most classic example of this is heart attacks. That's why people feel that pain in their arm or their jaw when their heart is what's actually hurting. So, that's the most classic example of what we do. But we get in there and actually treat not only the organ dysfunction but the nervous system's response to that and try and stop that reflex and that cycle from happening.

Dr. Mike Patrick: Now, you'd mentioned that relatively small numbers of DOs practice osteopathic manipulative medicine. How can parents and adult patients find the DO who does this?

Dr. Francis Comer: Great question. So, there's a couple websites that you can do, doctorsthatdo.org is one. And it's really great. It's put out nationally and it has a registry of all of us that do this. And you could search by your zip code and what radius you are willing to travel. And then, also by under specialty and there's a dropdown menu for specialty, and you can select OMT/OMM for that.

There's also The Osteopathic Cranial Academy, if you're looking for someone who specifically treats heads or for things like concussions or the plagiocephaly, those types of things. Because like I said, that is extra training for us, so not all of us do that.

Also, you can just Google "find a DO" and it will lead you to this website, too. So, you can do that and find what you need. And again, you're also welcome to reach out to me if you can make my email address public, I'm more than willing to help the answering drive people in the right direction.

1:02:15

Dr. Mike Patrick: Sure. Yeah, yeah. We'll put lots of resources in the Show Notes for this episode, 384, over at PediaCast.org.

And that website, Doctors That DO, or doctors that D-O.org is a great resource. And then also, in addition to the link to the folks who have information for colleges in medicine, the American Osteopathic Association also has a great website. Lots of information there, and I'll put a link to that in the Show Notes for this episode, 384, as well.

And then, there's also website for osteopathic manipulative medicine here at Nationwide Children's Hospital. And I think that does have your contact information on it.

Dr. Francis Comer: Yeah, it should.

Dr. Mike Patrick: And we'll put a link to that in the Show Notes, so folks can find you and get connected to osteopathy at Nationwide Children's as well. Now, for those..

Dr. Kimberly Wolf: Real quick. Sorry.

Dr. Mike Patrick: Yes, no please. Absolutely.

Dr. Kimberly Wolf: One thing I would add is make sure you call any office before you take especially a child. There are less of us who manipulate pediatric patients than adults, unfortunately. So, I would say even if you find a provider who's listed as one that does OMM, I recommend calling before you bring a child and make sure that they're comfortable with that population. So, that be my only other thing I'd add.

Dr. Mike Patrick: Yeah, absolutely. Maybe there's DO pediatricians out there who are interested in doing this. They think, "Oh, yeah I did had that training back in medical school sort of forgot about it." And other DOs as well for adult patients. Are there refresh opportunities the osteopathic providers could take, courses to sort of refine those skills again?

Dr. Kimberly Wolf: Yes, absolutely. So, the AOA puts on conferences that almost always having osteopathic manipulation component to them, as well as different sub-specialties often put on conferences. So, as a pediatrician, I'm most familiar with ACOP or American College of Osteopathic Pediatricians. But we always have a manipulation portion at our conferences.

1:04:19

The AAP, American Academy of Pediatrics, which is typically thought of us the allopathic organizations for pediatricians, has section on osteopathic pediatricians. And they actually have some osteopathic manipulation lectures at those national conferences as well. I'll actually be lecturing next year at the AAP's conference on manipulation for pediatrics.

So, again, those classes are out there and they're often at conferences you are already attending. There are also very specific courses that you can take if you have a specific interest. For example, learning more about cranial osteopathy through the Cranial Academy or the Sutherland Teaching Foundation.

Also, the American Academy of Osteopathy does a lot of education. And their national conference every year, which is called Convocation, is largely focused on osteopathic manipulation.

So there's also some really great resources if anyone is local here on Ohio through OU every year. They do an osteopathic skills refresher course. It's usually a weekend in October. And this year, I believe they're doing one in Athens, one in Columbus, and one in Cleveland at each of the three campuses. So again, check your local resources or if there's a school nearby. A lot of times they'll do courses like this.

Dr. Mike Patrick: Yeah. Great, great information. I imagine that there are MDs who are listening right now and thinking, "Well, okay, so I didn't go to an osteopathic medical school but really, I'm interested learning more about this and maybe doing some of these." Is it possible for allopathic physicians to learn and practice OMT?

Dr. Kimberly Wolf: Yes, it absolutely is. And we strongly encourage…

Dr. Mike Patrick: As we come together.

Dr. Francis Comer: That's right.

[Laughter]

1:06:02

Dr. Kimberly Wolf: We strongly encourage it, you do not have to be a DO to be an osteopath. You can still practice the osteopathic philosophy and incorporate it into your practice but also OMM. And as an allopath, you can also get paid for doing OMM. So that's important to know too. Because again, you want to know that you're going to be reimburse for that if you're going to incorporate it into your practice.

We are very proud that in the osteopathic residency here, we have one of our programs directors is Dr. Alex Rakowsky. I'm the co-director of that program with him. He's an MD, but we do like to call him one of our MDOs, he's our second MDO. Our first is Dr. Dane Snyder, who's one of the residence preceptors at the Hilltop Clinic. And both of them are actually doing some OMM in their practice through what we taught them.

Dr. Alex Rakowsky actually did do the Osteopathic Medicine for All course, which I helped teach. It was through OU, and it was targeted to teach MDs how to practice osteopathic manipulation. But we were especially focusing on those who precept osteopathic students and residents. So that even if there's not a DO in clinic, we're allowing and facilitating our students to practice those skills. But I'm very proud to say that both of those physicians are incorporating it in to their practice.

I think it's through Michigan State, they have been doing an Intro to OMM course that's targeted for MDs for the last two years, usually in June. And again, you can just sort of Google these things and they're out there. But again, local organizations are doing them as well. So, we strongly encourage that.

Dr. Mike Patrick: Yeah. As I was looking this up, I came across a very interesting article from the American Osteopathic Association called "Helping hands? DOs make case for teaching MDs OMT basics". And that was an interesting read. And I'll put a link in the Show Notes for that.

And then, also, the University of Wisconsin, their Department of Family Medicine has a course called Osteopathic Manipulative Treatment for the Allopathic Physician. And I'll put a link to that in the Show Notes as well. So, lots of opportunities.

1:08:11

Dr. Kimberly Wolf: Yeah. And one of the differences when we go back to talking about the training, there used to be specifically osteopathic and allopathic residencies, which is when we learn our specialty training like pediatrics or family medicine or surgery. And there is now — under the ACGME, which is the overseeing body — a single accreditation system. Meaning, they're unifying all of the residency programs so that anyone can apply to any of them.

In the past, osteopathic medical students could apply to either of the residencies but allopathic students were only eligible to apply to allopathic residencies. And with this new single accreditation system, allopaths or MDs and MD students are actually able to apply to osteopathic residencies.

So, for example, our residency here is accepting MD applicants and open to taking them and incorporating training in. We do have some prerequisites that we ask that you've done some training in OMM prior to coming here, because it is so integrated into our training. You'd be a little lost without that. But we are more than open to having them and excited to help train them because we just need more people out there doing what we do.

Dr. Mike Patrick: Yeah, because ultimately, we just want good health outcomes and this is one way that we can accomplish that. And I think that there is probably within the parent community too, I mean, there are folks gravitate more toward naturopathic type interventions rather than traditional medicine. And certainly there's a place for traditional medicine but having someone who's sort of buys in to both options, maybe someone that's kind of the same plane as that parent in terms of making them and helping their child. And then, even making the case for traditional medicine when it's needed.

1:10:02

Dr. Kimberly Wolf: Yes, Absolutely.

Dr. Mike Patrick: I should even say traditional because these things work, you know?

Dr. Kimberly Wolf: Yeah, absolutely.

Dr. Mike Patrick: Anyway, I'm just getting myself in trouble here.

[Laughter]

Dr. Kimberly Wolf: No, that's okay. We appreciate you educating and giving us a platform to let people know what we do.

Dr. Mike Patrick: Yeah. Well, I really appreciate the three of you stopping by and educating all of us. Again, we have lots of links in the Show Notes for folks with more information if you want to dig into this a little bit deeper. Those will be in the Show Notes for this episode, 384, over at PediaCast.org.

They wanted me to add one more resource to our list. And so, I have this link for you in the Show Notes over at PediaCast.org for this episode, 384. It's to the Ohio Osteopathic Association. It turns out they also have a great set of resources for you if you want to learn more about osteopathic medicine and want to hear more about osteopathic manipulative therapy. They have more info for you at their site. Again, the shoutout to the Ohio Osteopathic Association and we'll put a link to their website in the Show Notes for this episode.

1:12:03

Another link I want to remind you about, it was really a lot of fun taking the DISCOVERYx stage here at Nationwide Children's during my TEDx talk on how to engage families and colleagues with digital content. Just a little musings of my experience with podcasting and 11 years of putting these things together. And so that was a lot of fun. If you like to see me addressing the crowd at DISCOVERYx, be sure to check out that link, again in the Show Notes for this episode, 384, at PediaCast.org. We have a link to the YouTube video for you there. It's a lot of fun.

I want to remind you PediaCast is in all sorts of places. Wherever you found us, great. We're also in iTunes, Google Play, iHeart Radio, Stitcher, TuneIn, and most mobile podcast apps for iOS and Android.

And of course, there's the landing site, PediaCast.org, where you'll find our entire archive of past programs, as well as our Show Notes, transcripts, Terms of Use Agreement, and our Contact Page, so you can ask questions and suggest show topics.

We're also part of the Parents On Demand Network at parentsondemand.com. Lots of other great podcasts there for you on parenting.

We're also in social media, Facebook, Twitter, Google+, and Pinterest. And of course, appreciate it when you share the show with your own online audience. Really do appreciate that.

And there's nothing like face-to-face referrals, so be sure to let your family, friends, neighbors, co-workers, babysitters, daycare workers, grandparents, anyone who has kids or takes care of children, please let them know about PediaCast. So they can get up to speed on the best practices for child health that are evidence-based.

And that does include your child's doctor. Make sure you let them know about PediaCast so they can share the show with all their patients and families.

We also have a program for physicians and other medical providers who practice pediatrics. It's called PediaCast CME, that stands for Continuing Medical Education. It's similar to this program, we turn up the science a couple of notches and offer free Category 1 Continuing Medical Education Credit for those who listen and participate. Shows and details are available at the landing site for that program, which is PediaCastCME.org.

1:14:09

That show is also available in all the places that you can find PediaCast. So iTunes, Google Play, iHeart Radio. Just search for PediaCast and you'll find those CME programs as well.

Thanks again for stopping by. And until next time, this is Dr. Mike saying stay safe, stay healthy, and stay involved with your kids. So long, everybody.

[Music]

Announcer 2: This program is a production of Nationwide Children's. Thanks for listening. We'll see you next time on PediaCast.